You and I have corresponded about errors in WaPo’s HIV reporting in the past. To remind you, I am the science reporter at POZ magazine, a publication for people living with HIV. This particular article is littered with so many egregious errors and misunderstandings I would say it should be retracted entirely.
In order, the errors are:
- Truvada is an HIV drug, not an AIDS drug.
- Slow uptake of Truvada is not a function of people refusing to take it, rather of lack of awareness, difficulty accessing it, or not thinking they are at high enough risk to need it.
- Gay men didn’t really rejoice the 2012 approval of PrEP; most of them didn’t hear about it at all until the press started focusing on it in the fall of 2013.
- Truvada is not like a vaccine, because vaccines don’t have to be taken daily. It is pre-exposure prophylaxis—a form of ongoing prevention that requires adherence to a regimen.
- The Slate remark about PrEP being a miracle drug was made in 2014; the paragraph concerns things going on in 2012. Furthermore, the Slate author is no authority on HIV. His articles are littered with errors, especially his writing on PrEP. He is also, as you can see, prone to hyperbole.
- Obama’s AIDS-free generation vision pre-dates the excitement about PrEP. When his administration started using the expression, in December 2013, they were focusing on Africa, not here. Until recently, PrEP was only approved in the United States.
- It is not true that few people are using Truvada as PrEP. I just returned from a reporting trip to San Francisco, where men are using it in droves. Perhaps as many as 15 to 20 percent of at-risk gay men are on it. I’ve detailed how PrEP use is on a dramatic upswing in the U.S. in this article. Some rough estimates say that as many as 50,000 people are now on PrEP. I can tell you anecdotally that men in New York City are also using it at rising rates.
- The author neglects to note that between 2009 and 2014 HIV diagnosis rates leveled off among men who have sex with men (MSM) as a whole, including young MSM and black MSM (they have long been dropping among whites).
- A six percent rise in infections over 10 years does not constitute a “jump”.
- The estimate about six in 10 blacks becoming positive by 40 was about Atlanta men who have sex with men, not the whole country.
- The CDC only has one year of CDC diagnosis figures that reflect a year, 2014, when many people were using Truvada. So we cannot make any real conclusions yet about how it has affected HIV rates.
- Doctors are not worried about a mega-crisis. On the contrary, many are very excited that PrEP will help turn the tide against HIV transmissions in the U.S.
- Sex in 2016 is indeed safer than in the 80s if someone is on PrEP.
- To say that the fight against HIV is an either/or between fighting stigma an promoting PrEP is completely off the mark. I actually don’t know what he’s referring to here. And he says these campaigns come from doctors. Such campaigns typically come from health departments or community-based organizations.
- The writer completely misunderstands Truvada’s 2004 approval. It approved as HIV treatment at that time. PEP is something separate—it involves taking a triple cocktail of HIV drugs for 28 days within 72 hours of an HIV exposure to prevent infection. There are only two drugs in Truvada, not three.
- No, PEP did not just magically become PrEP with a “couple tweaks.” This is complete nonsense. A rigorous, massive, global clinical trials process proved PrEP’s efficacy in 2010. There have been numerous other clinical trials since then.
- “Unprotected sex” is no longer specific enough of a term in the age of PrEP. “Condomless intercourse” is the preferred term.
- The 57 percent figure is not nationally representative. It is a poll of men recruited at gay venues in about 20 major urban areas that the CDC conducts ever three years (it just released its most recent edition). It is also not representative of urban areas.
- That 21,000 figure is only a rough estimate. And it reflects where prescriptions likely were a year ago.
- The writer focuses on older studies of Truvada for his information about adherence to the daily regimen. More recent studies, and ones that are more reflective of real-world use, including the PROUD study in the UK, as well as a paper about a large San Francisco PrEP program, have found high levels of adherence.
- The whole “Truvada whore” thing is really fading.
- An 11 percent rate of people trying Truvada would actually be quite good, especially if those people are at higher risk of HIV than the others. There is evidence that men who are at higher risk are more inclined to take PrEP and more inclined to adhere to the regimen.
- Doctors’ awareness about and willingness to prescribe PrEP is increasing.
- Again, HIV rates are leveling off among gay men. They are still rising among Latino gay men, though.
To read more about PrEP and to look for sources for certain facts, I invite you to visit the PrEP page on my web site: www.benryan.net/prep.
Editor at Large